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- Title
The teaching and practice of cardiac auscultation during internal medicine and cardiology training. A nationwide survey.
- Authors
Mangione, Salvatore; Nieman, Linda N.; Gracely, Edward; Kaye, Donald; Mangione, S; Nieman, L Z; Gracely, E; Kaye, D
- Abstract
<bold>Objectives: </bold>To assess the time and importance given to cardiac auscultation during internal medicine and cardiology training and to evaluate the auscultatory proficiency of medical students and physicians-in-training.<bold>Study Design: </bold>A nationwide survey of internal medicine and cardiology program directors and a multicenter cross-sectional assessment of students' and housestaff's auscultatory proficiency.<bold>Setting: </bold>All accredited U.S. internal medicine and cardiology programs and nine university-affiliated internal medicine and cardiology programs.<bold>Participants: </bold>Four hundred ninety-eight (75.6%) of all 659 directors surveyed; 203 physicians-in-training and 49 third-year medical students.<bold>Interventions: </bold>Directors completed a 23-item questionnaire, and students and trainees were tested on 12 prerecorded cardiac events.<bold>Main Outcome Measures: </bold>The teaching and proficiency of cardiac auscultation at all levels of training.<bold>Results: </bold>Directors attributed great importance to cardiac auscultation and thought that more time should be spent teaching it. However, only 27.1% of internal medicine and 37.1% of cardiology programs offered any structured teaching of auscultation (P = 0.02). Programs without teaching were more likely to be large, university affiliated, and located in the northeast. The trainees' accuracy ranged from 0 to 56.2% for cardiology fellows (median, 21.9%) and from 2% to 36.8% for medical residents (median, 19.3%). Residents improved little with year of training and were never better than third-year medical students.<bold>Conclusions: </bold>A low emphasis on cardiac auscultation appears to have affected the proficiency of medical trainees. Our study raises concern about the future of this time-honored art and, possibly, other bedside diagnostic skills.
- Subjects
MEDICAL education; AUSCULTATION; INTERNAL medicine education; CARDIOLOGY; DIAGNOSIS; EDUCATION
- Publication
Annals of Internal Medicine, 1993, Vol 119, Issue 1, p47
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-119-1-199307010-00009